Obstructive sleep apnea syndrome in the pediatric age: the role of the dentist

Sleep disordered breathing in children designates a wide spectrum of respiratory disorders characterized by partial or complete obstruction of the upper airways. It ranges from primary snoring, its mildest clinical manifestation, to obstructive sleep apnea syndrome (OSAS): complete obstruction of the upper airways with cessation of airflow. The aim of this paper is to highlight the roles of the pediatric dentist and the orthodontist in the therapeutic approach to pediatric OSAS as a "sentinel" who can detect early signs of the disease for immediate referral to the otolaryngologist and as an active participant in therapy

Method of comparison equations for cosmological perturbations

We apply the method of comparison equations to study cosmological perturbations during inflation, obtaining the full power spectra of scalar and tensor perturbations to first and to second order in the slow-roll parameters. We compare our results with those derived by means of other methods, in particular the Green's function method and the improved WKB approximation, and find agreement for the slow-roll structure. The method of comparison equations, just as the improved WKB approximation, can however be applied to more general situations where the slow-roll approximation fails.Comment: 20 pages, 10 figure

Considerations on undistorted-progressive X-waves and Davydov solitons, Fröhlich-Bose-Einstein condensation, and Cherenkov-like effect in biosystems

Research in ultrasonography has evidenced the propagation of a peculiar kind of excitation in fluids. Such excitation, dubbed a X-wave, has characteristics resembling that of a solitary-wave type. We reconsider the problem in a medium consisting of a biological material of the like of alpha-helix proteins. It can be shown that in this case is expected an excitation of the Davydov's solitary wave type, however strongly damped in normal conditions. The case of acetanilide, an organic polymer which resembles biopolymers, is considered, and the infrared spectrum analyzed. Davydov's soliton is evidenced as a coherent state of polar vibrations. The case of acoustic (sound) vibrations is also considered, where, also, a damped Davydov-like solitary wave may be excited. However, it is shown that when traveling in conditions sufficiently away from equilibrium, more precisely, when the soliton is embeded in the resulting Frohlich-Bose-Einstein condensate, the lifetime of the solitary wave is largely enhanced. Moreover, a soliton moving in bulk with a velocity larger than that of the group velocity of the normal vibrational waves would produce a Cherenkov-like emission of phonons giving rise to the observed X-wave-like pattern. This paper is a modified and extended version of an earlier publication on the subject.489503Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Improved WKB analysis of Slow-Roll Inflation

We extend the WKB method for the computation of cosmological perturbations during inflation beyond leading order and provide the power spectra of scalar and tensor perturbations to second order in the slow-roll parameters. Our method does not require that the slow-roll parameters be constant. Although leading and next-to-leading results in the slow-roll parameters depend on the approximation technique used in the computation, we find that the inflationary theoretical predictions obtained may reach the accuracy required by planned observations. In two technical appendices, we compare our techniques and results with previous findings.Comment: REVTeX 4, 13 pages, no figures, final version to appear in Phys. Rev.

Lesch-Nyhan syndrome: evaluation of a modified bite device to prevent bite injuries

Lesch-Nyhan syndrome (LNS) is a serious form of hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency, a hereditary purinemetabolismdisorder. The prevalence reported in the literature is 1/380,000 to 235,000 births. Males are affected and females are heterozygous carriers. LNS patients present a combination of hypotonia, spasticity, and neurological and behavioral disorders. They also show an obsessive-compulsive self-injurious behavior with bites and injuries to the lips, tongue, cheeks and fingers. The literature offers little scientific contribution related to the management of this problem. The authors describe their experience with a 4-year-old LNS patient and present a viable solution to control and avoid bite injuries, namely a specifically modified bite. The patient was treated at the Pediatric Dentistry Department of "Sapienza" University of Rome with a modified bite with the internal surface, in contact with the teeth, realized in 2-mm-thick soft silicone, and the exterior part consisting of a transparent resin shell with front and rear shields to separate lips and cheeks from the dental arches. At a 12-month follow-up visit, compliance was excellent: the child wore the device with regularity and without discomfort, even during soft-food feeding. No intraoral bite injuries were found, with a general improvement of the young patient's quality of life

Co-evaluation of climate services. A case study for hydropower generation

Climate services are attracting growing attention and interest as instruments to promote climate change adaptation. The transparent assessment of the potential value brought by the services can play a major role. It can foster the commitment of the user towards a co-generation process increasingly central to climate services creation, can provide developers important information to better tailor the service to the user needs, and can finally increase recognition of the value of the service boosting confidence and trust in the tool. This study presents and then demonstrates the applicability of an evaluation methodology based on the Bayesian framework derived from the information value theory. The specific case study is the Smart Climate Hydropower Tool (SCHT), a climate service designed to support management decisions in hydropower generation. The service uses freely available seasonal forecasts and machine learning algorithms to predict incoming discharge to hydropower reservoirs. The user is ENEL Green Power Italy, and the testing environments are two water basins in Colombia. The study defines the expected value of perfect information, the expected value of the information currently used by the hydropower producer and the expected value of the service information. It then discusses pros and cons of the applicability of the method

Tonic-clonic seizures as a possible complication for cerebrospinal fluid leakage after intradural spinal surgery, a case report

Abstract Background Cerebrospinal fluid leakage is a well-known spinal surgery complication, especially in adults population. Pseudomeningocele is its most common manifestation and it can bring to some conditions, such as intracranial hypotension, infections and wound healing complication. Epilepsy is not classically associated to CSF leakage. We described a case of a female patient who developed tonic-clonic seizures associated with a pseudomeningocele after a detethering surgery. Case description A 16 year old female was admitted to our department for surgical treatment of a tethered cord for a sacral lipoma. Her medical history was remarkable mental retardation with psychiatric disturbs and hypothyroidism. She underwent a surgical intervention for the detethering of conus and dura was closed by a suture and fibrin glue. During third postoperative day she started to suffer a severe occipital headache, followed by tonic-clonic seizures. During suture removal, a collection suspected for a pseudomeningocele was found and chemical and radiological exams confirmed the dubious. Despite a continuous bed rest, collection continued to form. So, we decided to perform a surgical revision and to close dural defect. After intervention, patient did not suffer postural headache anymore and after 3 and 6 months she was found in good health. Conclusion We described the importance of significant morbidity, i.e. that of tonic clonic seizures as a sign of an occult CSF leakage after spinal surgery. Here, hydrocephalus as a condition was present, the change in pressure of CSF can determine seizures as well as promote this complication. A pseudomeningocele is not a trivial complication

Plasma levels of immunosuppressive mediators during cardiopulmonary bypass

The aim of this study was to evaluate plasma levels of two mediators with immunosuppressive properties, complement fraction C3a (C3a) and transforming growth factor-β1 (TGF-β1), during extracorporeal circulation. The proliferation index after phytohaemagglutinin (PHA) stimulation of isolated peripheral blood mononuclear cells was also investigated. Sixteen patients undergoing hypothermic (n = 8, group 1) and normothermic (n = 8, group 2) cardiopulmormry bypass (CPB) were enrolled in this study. As a control, we evaluated four patients undergoing thoracovascular operations without CPB. Blood samples were collected before CPB but after anaesthesia, every 30 min during CPB, at the end of CPB and 10 min after protamine administration. Both C3a and TGF-β1 increased significantly during CPB and after protamine administration in the hypothermic as well as the normothermic group. In the latter case the increase of C3a and TGF-β1, although more prominent, was not significantl higher than in the former group. Conversely, the proliferation, index of peripheral mononuclear cells had already decreased 30 min after CPB was started and remained depressed throughout the CPB time. These results suggest a possible role of C3a and TGF-β1 in the immunological changes occurring during extracorporeal circulation

Natural extensions and entropy of α\alpha-continued fractions

We construct a natural extension for each of Nakada's $\alpha$-continued fractions and show the continuity as a function of $\alpha$ of both the entropy and the measure of the natural extension domain with respect to the density function $(1+xy)^{-2}$. In particular, we show that, for all $0 < \alpha \le 1$, the product of the entropy with the measure of the domain equals $\pi^2/6$. As a key step, we give the explicit relationship between the $\alpha$-expansion of $\alpha-1$ and of $\alpha$

Shared Molecular Mechanisms among Alzheimer’s Disease, Neurovascular Unit Dysfunction and Vascular Risk Factors: A Narrative Review

Alzheimer’s disease (AD) is the most common type of dementia, affecting 24 million individuals. Clinical and epidemiological studies have found several links between vascular risk factors (VRF), neurovascular unit dysfunction (NVUd), blood-brain barrier breakdown (BBBb) and AD onset and progression in adulthood, suggesting a pathogenetic continuum between AD and vascular dementia. Shared pathways between AD, VRF, and NVUd/BBB have also been found at the molecular level, underlining the strength of this association. The present paper reviewed the literature describing commonly shared molecular pathways between adult-onset AD, VRF, and NVUd/BBBb. Current evidence suggests that VRF and NVUd/BBBb are involved in AD neurovascular and neurodegenerative pathology and share several molecular pathways. This is strongly supportive of the hypothesis that the presence of VRF can at least facilitate AD onset and progression through several mechanisms, including NVUd/BBBb. Moreover, vascular disease and several comorbidities may have a cumulative effect on VRF and worsen the clinical manifestations of AD. Early detection and correction of VRF and vascular disease by improving NVUd/BBBd could be a potential target to reduce the overall incidence and delay cognitive impairment in AD